Healthcare Provider Details

I. General information

NPI: 1326149964
Provider Name (Legal Business Name): VILLAGE OF GREENDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 NORTHWAY
GREENDALE WI
53129-1815
US

IV. Provider business mailing address

6500 NORTHWAY
GREENDALE WI
53129-1815
US

V. Phone/Fax

Practice location:
  • Phone: 414-423-2100
  • Fax: 414-423-2107
Mailing address:
  • Phone: 414-423-2100
  • Fax: 414-423-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN VICTORY
Title or Position: TREASURER
Credential:
Phone: 414-423-2100